Social Influences on Drinking Trajectories From Adolescence to Young Adulthood in an Urban Minority Sample

Family-Focused Prevention and Early Intervention of Substance Use in Pediatric Primary Care Settings

Prevention of substance misuse and substance use disorders is a national public health priority. The home environment can represent risk or protective factors for development of substance misuse. Children in homes with caregiver substance use are biologically, developmentally, interpersonally, and environmentally vulnerable to substance misuse and associated consequences, making it necessary for substance use prevention to focus on families early. Children and families who are minoritized, marginalized, and disenfranchised experience disproportionate consequences of substance use, through experiences of poverty, racism, trauma, and the built environment. Strengthening protective factors in early childhood by improving the health of caregivers and supporting the caregiver-child relationship can have enduring benefits over the life course. Pediatric primary care practices are an important setting for adopting a family-focused approach to prevention and early intervention of substance use. By engaging families early, identifying substance use in the family and household, recognizing the intersection of social needs and substance use, providing culturally tailored, trauma-informed, evidence-based care, and advising and supporting families on ways to minimize substance-related harm, pediatric care providers can play an important role in preventing substance use and substance-related consequences to children and families. Pediatric care providers are ideally suited to deliver prevention messages in a nonstigmatizing manner and serve as a conduit to evidence-based, family-focused intervention programs.

Drinking patterns among US men and women: Racial and ethnic differences from adolescence to early midlife

BACKGROUND

Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities.

METHODS

We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders.

RESULTS

NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts.

CONCLUSIONS

Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.

The Role of Socialization Contexts on Adolescent Substance Use across Racial and Ethnic Groups

Purpose of Review

This review summarizes theories and empirical work regarding socialization contexts contributing to substance use across marginalized adolescents. Future directions and recommendations to minimize the perpetuation of racial stereotypes are provided.

Recent Findings

Neighborhoods high in social cohesion may offset substance use risk. Promoting school connectedness via increased support from teachers and peers could reduce school-based discrimination and enhance feelings of belongingness. The influence of peers on substance use engagement largely differs across racial groups and level of acculturation. Family cultural values emphasizing respect, obedience, and collectivism offer protection from substance use.

Summary

Despite lower prevalence rates of adolescent substance use within racial/ethnic groups, rates of negative consequences due to substances are far greater compared to White adolescents. Transcultural factors (e.g., strong family ties), as well as culture-specific factors, should be leveraged to delay the onset of substance use and prevent negative sequelae resulting from substance use initiation.

Urbanicity and alcohol use epidemiology in the 21st century

PURPOSE OF REVIEW

This review aimed to gather recent studies that could identify the specificities in the relationship between urbanization and alcohol use epidemiology in the current century.

RECENT FINDINGS

Although we find lower rates of alcohol use among adolescents in urban environments than in rural ones, this difference tends to diminish until it disappears by the time they reach adulthood. In addition to excessive marketing and increased accessibility, several urban environment characteristics have been related to alcohol use. First, problematic alcohol use is linked to stress and mental health problems like depression and anxiety, which are common in metropolitan areas. Second, alcohol use behaviors are influenced by homelessness, loneliness, and deprivation in megacities, where female and male individuals have presented more similar alcohol use behaviors (i.e. gender convergence). Third, treatment levels for alcohol use disorders are very low.

SUMMARY

There is a new epidemiological wave of alcohol consumption in large urban centers, largely influenced by advertisement and marketing. Social and psychological risk factors and subpopulations of interest were identified for preventive interventions in large urban centers (i.e. advertisement regulation). In addition, increasing the availability of treatment, including specific medications for alcohol use disorder, should be strongly encouraged.

A Longitudinal Study of Alcohol and Cannabis Use in Young Adulthood: Exploring Racial and Ethnic Differences in the Effects of Peer and Parental Influences From Middle Adolescence

OBJECTIVE

This study assessed how changes from middle adolescence to young adulthood in peer and parental influences relate to frequency of alcohol and cannabis use in young adulthood and evaluated the differences between three racial/ethnic groups.

METHOD

The analytic sample (n = 2,808; 52.9% female; 54% Hispanic, 22.9% White, 23.1% Asian/Pacific Islander) was derived from a longitudinal cohort initially recruited from 16 middle schools in Southern California who completed annual surveys. Data were collected across six waves beginning in Spring 2013 (mean age = 16.2) through Spring 2019 (mean age = 21.6).

RESULTS

Multigroup latent growth models revealed consistent increases during adolescence and young adulthood in perceived peer and parental approval of alcohol and cannabis and in the amount of time spent around peers who used these substances. After we controlled for prior use, these increases related to alcohol and cannabis use at age 21, with few exceptions. The time spent around peers most strongly influenced later cannabis use for Hispanic young adults, whereas the influence of peer approval on later alcohol and cannabis use, and parental approval on later alcohol use, was strongest among White young adults.

CONCLUSIONS

The frequency of alcohol and cannabis use in young adulthood was shaped, in part, from increases in direct and indirect peer influence and perceived parental approval of substance use across two important developmental periods. The findings highlight the importance of early and sustained intervention efforts targeting these social influences, especially among White adolescents, which may potentially decrease alcohol and cannabis use as youth enter young adulthood.

Addressing adolescent substance use in an urban pediatric federally qualified health center

OBJECTIVE

Screening, brief intervention, and referral to treatment (SBIRT) is a systematic approach to identification and intervention for individuals at risk for substance use disorders. Prior research indicates that SBIRT is underutilized in pediatric primary care. Yet few studies have examined procedures for identifying and addressing substance use in clinics that serve publicly insured adolescents (i.e., federally qualified health centers [FQHC]). This descriptive, multi-method study assessed adolescent substance use frequency and provider perspectives to inform SBIRT implementation in an urban pediatric FQHC in California.

METHODS

A medical record review assessed substance use frequency and correlates among publicly insured adolescents aged 12-17 years who completed a well-child visit in pediatric primary care between 2014 and 2017 (N = 2252). Data on substance use (i.e., alcohol, illicit drugs, and tobacco) were from a health assessment tool mandated by Medicaid. Semi-structured interviews with 12 providers (i.e., pediatricians, nurse practitioners, behavioral health clinicians) elicited information about the current clinic workflow for adolescent substance use and barriers and facilitators to SBIRT implementation.

RESULTS

Of 1588 adolescents who completed the assessment (70.5%), 6.8% reported current substance use. Self-reported use was highest among non-Hispanic Black (15.2%) adolescents and those with co-occurring depressive symptoms (14.4%). Provider-reported challenges to implementing SBIRT included a lack of space for confidential screening and a lack of referral options. Providers favored implementing technology-based tools such as tablets for adolescent pre-visit screening and electronic medical record-based decision support to facilitate brief intervention and treatment referrals.

CONCLUSIONS

This study fills a substantial research gap by examining factors that impede and support SBIRT implementation in pediatric FQHC settings. Successful SBIRT implementation in these settings could significantly reduce the unmet need for substance use treatment among uninsured and publicly insured adolescents. Pediatric primary care and urgent care providers perceived SBIRT to be feasible, and health information and digital technologies may facilitate the integration of SBIRT into clinic workflows. Ensuring confidentiality for screening and expanding referral options for adolescents in need of community-based addiction treatment are also critical to increasing SBIRT uptake.

Perceived friendship and binge drinking in young adults: A study of the Human Connectome Project data

BACKGROUND

Peer influences figure prominently in young adult binge drinking. Women have trended to show a level of alcohol use on par with men during the last decades. It would be of interest to investigate the neural processes of social cognition that may underlie binge drinking and the potential sex differences.

METHODS

Here, we examined the data of the Human Connectome Project where we identified a total of 175 binge drinkers (125 men) and 285 non-binge drinkers (97 men) performing a social cognition task during brain imaging. We analyzed the imaging data with published routines and evaluated the results at a corrected threshold.

RESULTS

Both male and female binge relative to non-binge drinkers showed higher perceived friendship. Binge relative to non-binge drinkers demonstrated diminished activations in the anterior medial orbitofrontal cortex (amOFC) during perception of social vs. random interaction, with a more prominent effect size in women. Further, whole-brain regression identified activity of the right posterior insula (rPI) in negative correlation with perceived friendship score in non-binge drinking women. Post-hoc analyses showed significant correlation of rPI activity with perceived friendship, amOFC activity, and a summary measure of alcohol use severity identified by principal component analysis, across all subjects. Mediation and path analysis demonstrated a significant model: amOFC activity → rPI activity → perceived friendship → severity of alcohol use.

CONCLUSIONS

These findings support peer influences on binge drinking and suggest neural correlates that may relate altered social cognitive processing to alcohol misuse in young adults.

Alcohol trajectories and subsequent risk for opioid misuse in a cohort of urban adolescents

Background: The opioid epidemic is a public health emergency in the US. Alcohol is the most widely used addictive substance among all age groups; however, the contribution of different alcohol use trajectories throughout adolescence and young adulthood to the development of opioid misuse in young adulthood among urban minority youth has not been investigated. Methods: Data are from a study of 580 youth (85% African American, 67% low SES) residing in Baltimore City followed from ages 6-26. Alcohol trajectories were identified between ages 14 and 26 using group-based trajectory modeling. Opioid misuse was defined as using opioid painkillers without a prescription or using heroin between ages 19 and 26. Opioid misuse outcomes were also investigated separately. Logistic regression examined associations of alcohol trajectories with opioid misuse in young adulthood adjusting for socio-demographics, early use of tobacco and cannabis, neighborhood, and peer factors. Results: Six alcohol use trajectories were identified: Young adult increasing (21.4%), adult increasing (19.1%), abstaining (19.1%), experimenting (15.3%), adolescent increasing (14.8%), and adolescent limited (10.2%). In models fully adjusted for covariates, relative to the abstaining trajectory, the adolescent increasing trajectory was associated with an elevated risk of opioid misuse (aOR = 3.3, 95%CI = 1.4, 7.8) and prescription opioid misuse (aOR = 3.9, 95%CI = 1.4, 10.8) in young adulthood. Conclusions: Escalating alcohol use in adolescence and young adulthood is associated with an elevated risk of opioid misuse in young adulthood in a cohort of predominantly African American and socio-economically disadvantaged young people. Tailored interventions should target high levels of alcohol use during these developmental periods to reduce risk for opioid misuse among disadvantaged youth.

Adolescent Alcohol Use Trajectories: Risk Factors and Adult Outcomes

OBJECTIVES

Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates.

METHODS

Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years).

RESULTS

We identified 4 classes: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11-0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10-5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41-24.47).

CONCLUSIONS

Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).

Assessing the Mental Health of Brazilian Students Involved in Risky Behaviors

Adolescence, which is the transition from childhood to adulthood, is marked by emotional sensitivity and inconsistency and may be affected by mental health problems. In order to fill the gap related to the risky behaviors in students in Brazil, our cross-sectional study aimed to analyze the relationship between risky behaviors and indicators of mental health of Brazilian students. We used the data from the National School Health Survey to analyze the relationship between risk behaviors and three symptoms of mental health issues: feeling of being alone, number of close friends, and trouble sleeping due to worries. The sample consisted of 102,072 students in Brazil (48.3% boys and 51.7% girls), aged between 11 to 19 years. The risk behaviors evaluated were substance use, sedentary lifestyle, sexual behavior, and suffering violence and bullying. We have performed a multivariate analysis based on the Poisson regression model, and the measure of effect used was the prevalence ratio (PR) with confidence intervals (CI) of 95%. Our results showed that students with symptoms of mental health issues were involved in risky behaviors, including drug use and unsafe sex. Thus, mental illness outcomes may be associated with risky behaviors, or mental health may be impaired by them. Given these findings, in-school programs focused on improving mental health outcomes should be developed.

Space and Place in Alcohol Research

PURPOSE OF REVIEW

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

RECENT FINDINGS

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

SUMMARY

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.